# Why is healthcare in the USA such a clusterfuck? **URL:** \ **Category:** Great Debates\ **Created:** [June 6, 2015, 6:20pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805 "2015-06-06T18:20:43Z")\ **Posts on this page:** 20\ **Page:** 9
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [June 15, 2015, 4:15am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/161 "2015-06-15T04:15:51Z")
> [@watchwolf49](#): > > I’ve noticed that no one here is making the claim that health care service delivered in Canada is substantially better than the health care service provided here in the USA. Every Canadian has access to their health care system, but that’s true in the USA. Hospital emergency rooms have to accept every person who walks, or is carried, in through their doors. > > The difference is cost. Another difference is preventative or early care. “Access to emergency rooms” doesn’t equal “access to adequate medical care”. ---
**Author:** ![filmstar-en](https://avatars.discourse-cdn.com/v4/letter/f/50afbb/32.png) [@filmstar-en](https://boards.straightdope.com/u/filmstar-en)\ **Post date:** [June 15, 2015, 9:40am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/162 "2015-06-15T09:40:50Z")
How are statistics collected about illnesses of people who are uninsured or cannot afford a doctor? Are they not effectively ‘under the radar’ of the government? There must be a lot of hidden illness and chronic conditions that people endure or try to self medicate because they cannot afford the medical cover they need. :eek: ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [June 15, 2015, 2:08pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/163 "2015-06-15T14:08:48Z")
> [@Nava](#): > > Another difference is preventative or early care. “Access to emergency rooms” doesn’t equal “access to adequate medical care”. Or taking it back a step further educating the public on preventative measures - for which there is a huge incentive in UHC models. About this time of year you start seeing breast scanning trucks in public parks and other heart/blood/fat measuring stuff. ---
**Author:** ![watchwolf49](https://avatars.discourse-cdn.com/v4/letter/w/e9c0ed/32.png) [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)\ **Post date:** [June 15, 2015, 2:19pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/164 "2015-06-15T14:19:36Z")
> [@Northern\_Piper](#): > > That said, two of the most commonly used statistics to compare health care systems in different countries are the rates for infant mortality, and life expectancy, because these are fairly objective and are generally believed to be tied to the quality of health care. My point is that these two statistics are _relatively_ close, compared to profit. Can we assume that the USA system is ten times as profitable than the Canadian system? This may well be an understatement if there is no profit to be had in Canada. Here’s the shocker, it is illegal for a USA investor to buy shares of stock in Japanese clinics, whereas any Japanese investor is free to invest as much as they want in USA clinics. Can a Canadian invest in Canadian hospitals and expect a return, dividends or capital gains? By the metric of “return on investment”, the USA system is superior in every way to the Canadian system. Someone mentioned up-thread about how much money would be “saved” if we reformed the USA system, but that only applies to a certain group of people. There will be another group of people for which this money is “lost”. Certainly the evil one-percenters, but also many elderly widow women are holding health care service securities as part of their balanced portfolio. How many Canadian elderly widow women hold positions in the USA health care system? It’s about “point of view”, if one is struggling to make that monthly premium payment, then reform is best … if one is receiving $100,000 in dividends every year, reform is out of the question. Again, it’s the culture here in the USA, dollar for dollar, we have complete equality (the more dollars you have, the more equality you get). ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 15, 2015, 2:22pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/165 "2015-06-15T14:22:10Z")
> [@up\_the\_junction](#): > > That article is a nonsense - it’s ‘admin’, you know, all that insurance paperwork … right. The US spends more on administration _alone_ than the entire budget of the NHS and Bupa combined. Yes, doctors make a lot more money here but really that’s not a major cost driver. Doctors have always made a lot of money and it’s a long time before they are enjoying the fruits of those earnings rather than paying down student debt. > [@up\_the\_junction](#): > > I don’t know how this works. Is Medicare still charged by professionals at the same rate as private work? No. Medicare reimbursement rates are lower. When you’re the biggest gorilla, you can do that. Of course, if we were _all_ on Medicare… alas, it won’t happen. I wouldn’t take any of **Clothahump** ’s posts on the subject seriously. He never has any idea what he’s talking about and he is unlikely to return to this thread to provide citations or to respond to anyone who points out he’s wrong. > [@filmstar-en](#): > > How are statistics collected about illnesses of people who are uninsured or cannot afford a doctor? > Are they not effectively ‘under the radar’ of the government? They will go to emergency rooms when they are sick, and the ER will write off the cost of their visit. There is certainly a data gap for people who have enough income to make it worthwhile to bill them, but not enough to actually afford their hospital bills. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [June 17, 2015, 2:12am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/166 "2015-06-17T02:12:16Z")
> [@watchwolf49](#): > > Someone mentioned up-thread about how much money would be “saved” if we reformed the USA system, but that only applies to a certain group of people. There will be another group of people for which this money is “lost”. Certainly the evil one-percenters, but also many elderly widow women are holding health care service securities as part of their balanced portfolio. How many Canadian elderly widow women hold positions in the USA health care system? Oh! Oh! I know this one! Most individuals who hold securities see very little of their income from them. Something less than 5%. Very, very few persons overall count income from securities as a significant part of their income. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 17, 2015, 2:52am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/167 "2015-06-17T02:52:00Z")
> [@watchwolf49](#): > > My point is that these two statistics are _relatively_ close, compared to profit. Can we assume that the USA system is ten times as profitable than the Canadian system? This may well be an understatement if there is no profit to be had in Canada. Here’s the shocker, it is illegal for a USA investor to buy shares of stock in Japanese clinics, whereas any Japanese investor is free to invest as much as they want in USA clinics. Can a Canadian invest in Canadian hospitals and expect a return, dividends or capital gains? > > By the metric of “return on investment”, the USA system is superior in every way to the Canadian system. > > Someone mentioned up-thread about how much money would be “saved” if we reformed the USA system, but that only applies to a certain group of people. There will be another group of people for which this money is “lost”. Certainly the evil one-percenters, but also many elderly widow women are holding health care service securities as part of their balanced portfolio. How many Canadian elderly widow women hold positions in the USA health care system? It’s about “point of view”, if one is struggling to make that monthly premium payment, then reform is best … if one is receiving $100,000 in dividends every year, reform is out of the question. > > Again, it’s the culture here in the USA, dollar for dollar, we have complete equality (the more dollars you have, the more equality you get). I don’t understand your logic. If we were only spending 10% of GDP on health instead of 18%, and our outcomes were the same (our outcomes are generally the same as any other wealthy country, in some ways better in other ways worse) that frees up 8% of GDP to spend on other things. The entire military is about 4%. Providing free public college to everyone who applies would cost \<1% of GDP. So you could have a humane health care system, a free military and free college and still save $500 billion a year if our health system were as efficient as an average European system. Your argument about elderly widows isn’t too persuasive. By that logic, we shouldn’t sell CFL lightbulbs because the old incandescents used more electricity which was good for the handful of retirees whose portfolios had energy stocks in them. Why not go back to the days when people spent 30% of their income on food because it helped the farmers? Either way, non-profit health systems in the US are still about 2x as expensive as any other wealthy nation. Profit isn’t the problem, the problem is a lack of public and private market forces to drive down costs and drive up quality. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 17, 2015, 4:28am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/168 "2015-06-17T04:28:44Z")
> [@watchwolf49](#): > > My point is that these two statistics are _relatively_ close, compared to profit. Can we assume that the USA system is ten times as profitable than the Canadian system? > … > By the metric of “return on investment”, the USA system is superior in every way to the Canadian system. That’s a good argument, if the primary purpose of a health care system is to allow investors to make money. If, on the other hand, one thinks that the primary purpose of a health care system is to, you know, keep people living longer and keep li’l babies from dying, it’s a pretty lousy measurement. > [@watchwolf49](#): > > This may well be an understatement if there is no profit to be had in Canada. Here’s the shocker, it is illegal for a USA investor to buy shares of stock in Japanese clinics, whereas any Japanese investor is free to invest as much as they want in USA clinics. Can a Canadian invest in Canadian hospitals and expect a return, dividends or capital gains? Hospitals are pretty much publicly run and funded, so no, no investment options there. Medical clinics are owned by the doctors, who make their money from the medicare payments, but cannot form public corporations to provide physician services. Labs can be private corporations, so one could invest in them. > [@watchwolf49](#): > > Someone mentioned up-thread about how much money would be “saved” if we reformed the USA system, but that only applies to a certain group of people. There will be another group of people for which this money is “lost”. Certainly the evil one-percenters, but also many elderly widow women are holding health care service securities as part of their balanced portfolio. I think that the US securities market is so vast, that it’s possible to invest one’s money and get a good return on investment even if it were not possible to invest in health care as currently structured. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [June 17, 2015, 4:51am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/169 "2015-06-17T04:51:45Z")
> [@watchwolf49](#): > > Here’s the shocker, it is illegal for a USA investor to buy shares of stock in Japanese clinics… Is that a USA law? Can you tell me exactly which law forbids it? Is it also true that a USA investor cannot buy shares in publicly listed Japanese pharmaceutical companies or medical equipment manufacturers? ---
**Author:** ![Claverhouse](https://avatars.discourse-cdn.com/v4/letter/c/13edae/32.png) [@Claverhouse](https://boards.straightdope.com/u/Claverhouse)\ **Post date:** [June 17, 2015, 8:27am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/170 "2015-06-17T08:27:28Z")
One could indefinitely paralyse reform of anything by granting a small amount of stock to elderly widows. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 17, 2015, 1:49pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/171 "2015-06-17T13:49:10Z")
> [@foolsguinea](#): > > Oh! Oh! I know this one! > > Most individuals who hold securities see very little of their income from them. Something less than 5%. Very, very few persons overall count income from securities as a significant part of their income. In all seriousness, moving the US to a single-payer or other UHC model would wipe out millions of jobs. My wife would be made redundant at a stroke; she’s a muckety-muck in an HR benefits management outsourcing firm, who specializes in healthcare benefit management. If she was lucky she might be able to move into managing pension or 401(k) benefits but the former is shrinking and the latter doesn’t require much human involvement of the type she does. I would probably be out of a job in short order, too, because about 60% of my law practice involves medical care-related litigation. Despite all that (perhaps because of all that, in fact, since we are both in a good position to observe the inefficiency), we are both in 100% agreement that the current US model is a hopeless mess and needs to be replaced. > [@Northern\_Piper](#): > > That’s a good argument, if the primary purpose of a health care system is to allow investors to make money. I think he was being facetious. > [@Isamu](#): > > Is that a USA law? Can you tell me exactly which law forbids it? Is it also true that a USA investor cannot buy shares in publicly listed Japanese pharmaceutical companies or medical equipment manufacturers? Japanese law essentially prohibits for-profit hospitals; hospitals are required to reinvest any profits in capital improvements. So you _could_ theoretically minvest in a Japanese hospital, but you couldn’t actually make any money doing it. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [June 18, 2015, 12:52am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/172 "2015-06-18T00:52:17Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Japanese law essentially prohibits for-profit hospitals; hospitals are required to reinvest any profits in capital improvements. So you _could_ theoretically minvest in a Japanese hospital, but you couldn’t actually make any money doing it. That’s not what he said. He said “it is illegal for a USA investor to buy shares of stock in Japanese clinics”. FYI, there are many private medical clinics (neighborhood GPs) that are allowed to make a profit. Some of them make a boatload of profit though I don’t know whether any have gone public. That doesn’t mean you couldn’t invest in them though, unless US law forbade it. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [June 18, 2015, 2:13am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/173 "2015-06-18T02:13:33Z")
> [@watchwolf49](#): > > By the metric of “return on investment”, the USA system is superior in every way to the Canadian system. > > Someone mentioned up-thread about how much money would be “saved” if we reformed the USA system, but that only applies to a certain group of people. There will be another group of people for which this money is “lost”. Certainly the evil one-percenters, but also many elderly widow women are holding health care service securities as part of their balanced portfolio. Investors have the unmitigated gall to make money off of fellow citizens who are ill? That is obscene. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 18, 2015, 1:28pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/174 "2015-06-18T13:28:26Z")
> [@Isamu](#): > > That’s not what he said. He said “it is illegal for a USA investor to buy shares of stock in Japanese clinics”. So he did. Whoops! ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 18, 2015, 2:08pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/175 "2015-06-18T14:08:08Z")
> [@Really\_Not\_All\_That\_Bright](#): > > I think he was being facetious. In threads discussing US healthcare, I’ve given up trying to detect when it’s sarcasm and when it’s straight. 😃 ---
**Author:** ![Smartass](https://avatars.discourse-cdn.com/v4/letter/s/4491bb/32.png) [@Smartass](https://boards.straightdope.com/u/Smartass)\ **Post date:** [June 18, 2015, 8:20pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/176 "2015-06-18T20:20:07Z")
While a few posters in this thread have commented on it, I think that in general discussion there is a failure to recognize how much of the cluster in the U.S. is tied to [ul] [li]The power that a few health insurance companies have in the market.[/li]li Customers having almost no power because of employers making the insurance purchasing decisions.[/ul][/li]At some point in the past, employer-provided healthcare sounded like a good idea. I think our experiment shows that it was not. Here’s the thing I can’t figure out about the ACA: How could anyone possibly think that forcibly providing the insurance companies with more customers might be a good “solution”? We have a solid mythology going in the US that pharmaceutical companies are the problem. I don’t see how we’re ever going to come up with viable solutions without an ability to recognize who the really bad guys are. -VM ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [June 18, 2015, 9:34pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/177 "2015-06-18T21:34:49Z")
> [@Smartass](#): > > Here’s the thing I can’t figure out about the ACA: How could anyone possibly think that forcibly providing the insurance companies with more customers might be a good “solution”? Dude, you have an entire political class that is corrupt - bought and paid for. It’s a miracle things got this far. ---
**Author:** ![Smartass](https://avatars.discourse-cdn.com/v4/letter/s/4491bb/32.png) [@Smartass](https://boards.straightdope.com/u/Smartass)\ **Post date:** [June 18, 2015, 11:54pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/178 "2015-06-18T23:54:02Z")
> [@up\_the\_junction](#): > > Dude, you have an entire political class that is corrupt - bought and paid for. It’s a miracle things got this far. You’re wrong: They are not bought and paid for; they are _leased_. Payments are due every term… -VM ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [June 19, 2015, 12:59am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/179 "2015-06-19T00:59:04Z")
> [@Smartass](#): > > Here’s the thing I can’t figure out about the ACA: How could anyone possibly think that forcibly providing the insurance companies with more customers might be a good “solution”? If they have more vic-er, customers, do they not make more money? ---
**Author:** ![Melbourne](https://avatars.discourse-cdn.com/v4/letter/m/b5e925/32.png) [@Melbourne](https://boards.straightdope.com/u/Melbourne)\ **Post date:** [June 19, 2015, 7:44am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/180 "2015-06-19T07:44:59Z")
> [@carnivorousplant](#): > > How so? If some wealthy guys are becoming more wealthy, they will resist change, and they own senators and representatives. > > The father of a friend is an anesthesiology nurse. His home costs two million. How many guys who make that much money and more are involved in each and every surgery? If you mean a nurse anesthesist, there are two people who make as much and more: him and the surgeon. If you mean the nurse specifically responsible for patient care,maybe around 6. Either could stretch to a two million house, but if he’s not a nurse anesthesist, I’d guess that his wife is working also. [Previous page](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805.md?page=8) [Next page](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805.md?page=10)